The Ageing Stone

For those outside the United Kingdom this is the way we spell ageing. I have often wondered why we spell it differently? It does not really matter as I like the diversity of language! Anyway in this blog post I explain the story behind my sculpture. I explain why I made it and why it is just a simple block of stone that is made to such exact proportions.

The Ageing Stone currently appears like this (1st January 2014):

Even stone ages. Here the curious patterns that have developed on it could never have been predicted. This is after just 6 months. Ageing is part of us all. Perhaps the Ageing Stone might remind us all of the of passing time and the world we live in really does matter. This creates a diversity that is to be celebrated. True science will always appreciate this real-world reality!

I wrote the following explanation just after the Ageing Stone had been finished. That was June 2013:

The Ageing Stone represents more than just DSM-IV-TR diagnosis of ‘294.1x Dementia of an Alzheimer’s Type.’

Today’s scientific progress has informed a prevailing understanding that such a diagnosis could not be represented in Art. Dementia of an Alzheimer’s Type is, after all the most scientific of diseases, and with so much research effort behind it, that we simply just ‘ken’ (in Scottish vernacular) that it is beyond dispute. We are collectively now so sure about this diagnosis that in public, and indeed in professional discourse, we have felt able to shorten it to one word “Alzheimer’s.”

Yet why does this doctor still find, that in his surgery, the first question generally asked about “Alzheimer’s” is how does it relate to dementia? The majority of the medical profession (it seems to this artist) consider this a silly question. Yet, Brayne and Hatch, like the Ageing Stone, ask with an open mind in their British Medical Journal Editorial of 2010[1]: ‘What do we mean by Alzheimer’s Disease?”

The Ageing Stone has seen the 100 year old concept of Alzheimer’s disease grow from a disease that once only referred to younger patients to a worldwide “epidemic” in our elderly[2]. The “burden” of this “epidemic” seems now so great that in 2012, the British Prime Minister, David Cameron, demanded that Britain undertook an “all out fight back” against this disease[3].

The Ageing Stone has witnessed fifty years of brain research into this disease at a molecular level. Based on the results, the leading UK expert in Alzheimer’s Disease, Prof Clive Ballard, concluded in his recent lancet Editorial [4] that “the paradigmatic brain pathology of Alzheimer’s disease – plaques and tangles – is only a post-mortem finding of limited explanatory value in the expression of dementia in the population.”

The DSM-IV-TR diagnosis of ‘294.1x Dementia of an Alzheimer’s Type’ requires “significant” impairment in an affected person’s overall function. The seemingly universal imperative for “early diagnosis”, well-intended as it may be, appears to be currently re-defining what scientists, doctors and indeed the whole western world considers “significant”. The Ageing Stone is helplessly inanimate to the re-definition of what we mean by“significant.”The Ageing Stone, were it able, would express concern about departure from evidence based science. One word can indeed matter even to biological science.

Evidence that is robust and repeated many times over has fully established[5] (through intensive pharmaceutical industry research) that, at the very most, nomore than 50% of our elders with mild memory loss will ever progress to what DSM-IV-TR refers to as a diagnosis of ‘294.1x Dementia of an Alzheimer’s Type.’

The Ageing Stone understands the importance of scientific research: in this case, that at least one-half of our elderly with mild memory loss (due to a whole host of unscientific reasons) risk being labelled as suffering from “Alzheimer’s”. Some sociologists[6] concerned about this cultural shift have coined the term “Alzheimerisation.” Reasons for this cultural shift may include existential fear, disease mongering, the marketing opportunity for potential interventions and indeed the very reality of dementia and an ageing demographic.

Paul Higgs and Ian Rees-Jones, the sociologists behind the term ‘Alzheimerisation’, also referred to this as the ‘death of old age’. The Ageing Stone might be sub-titled the ‘death of old age’ as it reflects in stone the beauty of natural ageing: ageing that naturally leads to our death.

The Ageing Stone asks if biological reductionism (fundamental as our biology is to our basis) may be sufficient to be the only definition of mankind? Our approach to dementia would be a WORLD (spelled) backwards if we did not at least consider this question. [7] We must properly appreciate that isolated tests of cognition (important as they are) do not alone represent our elderly as the living breathing windfall of experienced individuals of whom we should value, whether they live with, or without, dementia.

The Latin inscription carved on the front of the Ageing Stone is taken from the last four lines of a poem of 1724 enlightened Edinburgh and is carved still on the now ruinous William Adam house of Mavisbank, 6 miles outside Edinburgh.

And may God concede that you grow old either never or late, and that you experience earthly changes late. And may what the numerous ages erode be restored intact, and may it be granted that the older you are, the more beautiful you may shine.

The Ageing Stone is simply a 1:20 scale representation of Mavisbank in its exact proportions. This is a house, whilst a ruin today, is still considered by many as Scotland’s, and possibly Europe’s, finest small house of this period[8].

Embodied in the story of Mavisbank house is a beautiful blended narrative of ‘two cultures’ – science and art. C.P Snow was surely correct to fear the potential consequences of their division? The Ageing Stone, in the beautiful, but simple proportions of Mavisbank, reminds us of the need for proportional inclusion between these ‘cultures’ and for the folly of one imagined to linger without the other[9].

Carved on the top of the Ageing Stone is Sir Walter Scott’s ‘The Antiquary” a name he latterly employed as his pen-name[10]. Walter Scott started his writing career in a cottage on the land nestling next to Mavisbank’s 18th century designed landscape. The Antiquary is preoccupied with time. The Antiquary, like UnderMilk Wood[11], reminds us that “time passes. Listen. Time passes.” The DSM-IV-TR diagnosis of ‘294.1x Dementia of an Alzheimer’s Type’ seems to completely ignore passing time.

“The Antiquary has been perhaps the most persistently underestimated work of our most persistently underestimated major writer . . . The Antiquary is preoccupied on every level by the relation between past and present.”Nicola J. Watson

The last child to grow up in Mavisbank house before it became a ruin is now a 70 year old man and a friend of this artist. David Hume Stewart Harrowes was born in Edinburgh on 6th April 1943. The Artist would like you to engage with the Ageing Stone (we do not need science to tell us that we age) and so if you so wish, each year on the anniversary of 6th April 1943 you are most welcome to come and take your photograph beside the Ageing Stone. A gallery of photos at the end of your life may help us all remember that whether as stone or being we pass through time, and that we are more than the diagnostic sum of any classification absurdly free of narrative.

[6] Higgs, P & Rees-Jones, Medical Sociology and Old Age: Towards a sociology of health in later life. Published by Routledge, March 2013

[7] Until recent copyright a cognitive test, devised by Folstein in 1987, was used universally. It is known as the MMSE (Mini-MentalState Examination) and one of its questions was to spell the word ‘WORLD’ backwards.

I work in Scotland for the National Health Service as a psychiatrist for older adults. I have degrees from two Scottish Universities in Medicine and in Social Sciences. My further interests include evidence-based medicine, philosophy, ethics and medical humanities. One of my hobbies is film-making. I write here in a personal capacity only. Follow me on twitter @PeterDLROW.

Very thought-provoking post – thank you. I like the photo that shows “Arts” on one side and “Science” on the other. Not just science, front and center. They are together as they were in the poetic function of the brain, in the middle part, as described in The Faerie Queene, canto ix, st. 53, which also produces philosophy and law. If those three parts of the brain that Spenser described – good memory at the back (an old man called Eumnestes), the middle part which is judgment and concerned with the present, and the front of the brain, with a melancholy figure known as Phantastes, who has the difficult job of distinguishing the real from the fantasy – then which part does dementia or Alzheimer’s affect? I know this is an unfair question, completely out of left field, but really, what does neuroscience have to say about how our brains work to give rise to our identity, and how does it pretend to grapple with that thing known as consciousness? In my line of work as an elder law attorney, I remind adult children of elders that for many people much of aging is about loss – losses of capacity, capability and autonomy. We have never had so many old people on the face of the earth before. I don’t think this is actually a medical problem, it’s much more complicated than that! But what does this reductionist focus say about our human dignity and value as a person? As long as so many of us focus exclusively on the loss, trying to correct the challenges of aging as if they were only disease-based, pushing pills to help people cope with a difficult situation, I think we will squander our resource of elders.